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NPI Code Detail

MEDICARE: CHERIE HAYDOCK MS RD LD CNSD

MEDICARE:   CHERIE  HAYDOCK  MS RD LD CNSD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian1445MN

General Provider Information

NPI Number : 1467514612
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERIE HAYDOCK MS RD LD CNSD
Provider Business Mailing Address
First Line : 7455 FRANCE AVE S
Second Line : SUITE 172
City : EDINA
State : MN
Zip : 55435-4702
Country : US
Telephone Number : 612-418-8194
Fax Number :
Provider Business Practice Location Address
First Line : 393 DUNLAP ST N
Second Line : SUITE 833
City : SAINT PAUL
State : MN
Zip : 55104-4200
Country : US
Telephone Number : 651-644-7775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 07/08/2007

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Directions to “ CHERIE HAYDOCK MS RD LD CNSD” Practice Location

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